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Thursday, February 7, 2013

She Dou (Sp 17) "Food Hole"...a Forgotten Acupoint we should use!

Most Chinese-trained acupuncturists rarely use the point Shi Dou.
It is not considered an important or particularly useful point
according to current Chinese acupuncture education. In fact, it is
probable that most Western acupuncturists promptly forget everything
about this point after taking their licensure exams and would be more
likely to use its neighbor, Da Bao (Sp 21) if a local point in this region were required.
However, according to the Bian Que Xin Shu (Bian Que’s Heart Writings), a Song dynasty text by Dou Cai as interpreted by Sung Baek in his book Classical Moxibustion Skills in Contemporary Clinical Practice,1
direct moxibustion of this point with tiny threads of high grade
mugwort moxa is singularly useful in many if not most cases of spleen qi
vacuity, liver-spleen disharmony, spleen dampness, and especially where
the qi mechanism (upbearing and downbearing) is impaired due to a
combination of liver depression, qi vacuity, dampness, and heat existing
all at the same time. In fact, when reading author Sung Baek’s
description of this point’s uses, what he appears to be describing is Li
Dong-yuan’s yin fire theory. There are several sites in his book that
support this idea.
In one case, Baek states that moxa on this point is of vital
importance in cases of edema with urinary retention and the inability to
breath when lying down. This symptom picture suggests that treatment
must downbear turbid counterflow qi and also supplement the lung qi (by
supplementing the spleen qi) so that is can properly depurate and
downbear both qi and body fluids.
In another case, he suggests using Shi Dou for the treatment
of spleen stomach damage with dry heat above due to excessive
consumption of cold food causing loss of communication between the three
warmers. This again suggests that moxa on this point promotes qi
rectification, clearing of heat, and spleen qi supplementation.
In a third case, the same author suggests applying 300-500 threads of
moxa on Sp 17 in case of chronic malaria in order “to balance hot and
cold within the body” by fortifying the spleen.
Finally, he suggests the use of moxibustion on this point for all
types of edema due to inadequate engenderment of latter-heaven qi by the
spleen, in cases of high fever but where the lower limbs are cold, in
cases of diarrhea due to spleen qi vacuity, nue-type diseases
with alternating fever and chills, vomiting and loss of appetite, yellow
jaundice with red-colored urine and yellow eyes due to cold damage, and
chest and rib-side pain due to poor digestion. Also, he insists that
these complex disorders must be treated first by fortifying spleen qi.
He further states that treating Shi Dou on the left is for specifically for supplementing the spleen, while, on the right, it is for soothing the liver.
In searching for other views on the use of this point, I found that Felix Mann’s The Treatment of Disease by Acupuncture, which is a translation of the treatment formulary section of the Zhen Jiu Da Cheng (Great Compendium of Acupuncture & Moxibustion), states that Shi Dou
can be used to treat chest and limb heaviness, diaphragmatic pain,
intermittent fever of the spleen, paralysis and numbness, ascites, and
pulmonary congestion. Again, if we look at these symptoms, we see the
disease mechanisms of spleen qi vacuity, blood vacuity, dampness, and
liver depression qi stagnation with possible damp heat.
According to Li Dong-yuan, the disease mechanisms of yin fire include
spleen qi vacuity, liver depression, damp heat, yin and/or blood
vacuity with vacuity heat, and stirring of ministerial fire. If one
analyzes his treat protocols, it becomes clear that, to treat this kind
of complex disease mechanisms, one must, at the very least, supplement
the spleen, rectify the qi, and clear heat, as well as doing whatever
else is necessary in each patient’s case. Based on Baek’s and Mann’s
description of this point’s effects, we see that it is exactly these
disease mechanisms which are being treated. We also see that they are
discussing difficult-to-treat, complicated conditions similarly to Li
Dong-yuan.
As a final note, it is my own clinical experience that this point
will be tender, often exquisitely so, when it is most needed. I also
agree that it is necessary to burn many, but very tiny, moxa
threads on the point, usually at least 50 and often as many as 200.
Needling the point is not suggested as a replacement for moxibustion
since the two types of therapy do not perform the same functions as well
as the fact that it is just over the lateral lung in a very slender
person. If time does not permit you to treat both sides with moxa, I
suggest using the right side, since it is away from the heart and
prevents the possiblity adding unwanted heat to that organ (although I
have not had that happen in actual clinic practice). I have used this
point with excellent results on many patients and hope you will consider
it the next time you encounter a patient with a similar complex
condition. Knowing the type of patients that most of us see every day,
you may find yourself treating this point on a regular basis.
For more information about moxibustion, see Lorraine Wilcox’s Moxibustion: Modern Clinical Handbook and Moxibustion: The Power of Mugwort Fire. For more on yin fire theory, see Bob Flaws translation of The Treatise on the Spleen and Stomach and his one-hour online course, Li Dong-yuan’s Theories on Internal Damage Disorders.